Scheinin B, Lindgren L, Rosenberg P H
Department of Anaesthesia, University Central Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 1989 Feb;33(2):156-9. doi: 10.1111/j.1399-6576.1989.tb02880.x.
The effect of intrapleural bupivacaine in the treatment of post-thoracotomy pain was evaluated. Bupivacaine, 0.5% 20 ml, with adrenaline (5 micrograms/ml) was given through an indwelling intrapleural catheter, at 4-h intervals four times daily for 2 days. No pleural suction was applied during and 10 min after each injection. A control group received intramuscular oxycodone on request. A visual analogue scale (VAS), a pain questionnaire (PQ) and registration of the need for supplementary analgesics were used for the assessment of postoperative analgesia. Blood-gas analyses showed elevated PaCO2 values in both groups on the day of operation and on the first postoperative day, without differences between the groups. Plasma concentrations of bupivacaine did not reach toxic values, and no symptoms of central nervous toxicity or any other untoward reactions were found during the study period. Clinically, there was some pain relief after the intrapleural bupivacaine. The VAS and PQ scores 30 min after bupivacaine instillations diminished to an extent similar to that after oxycodone treatment. The need for analgesics during the day of operation was less in the bupivacaine group than in the control group (P less than 0.001). The number of oxycodone supplementation doses during 48 h postoperatively was, however, not smaller in the bupivacaine group than in the control group.
评估了胸膜腔内注射布比卡因治疗开胸术后疼痛的效果。通过留置的胸膜腔导管给予0.5%布比卡因20 ml加肾上腺素（5微克/毫升），每4小时1次，每日4次，共2天。每次注射期间及注射后10分钟不进行胸膜腔抽吸。对照组按需接受肌内注射羟考酮。采用视觉模拟评分法（VAS）、疼痛问卷（PQ）以及记录补充镇痛药的需求情况来评估术后镇痛效果。血气分析显示，两组在手术当天及术后第1天的动脉血二氧化碳分压（PaCO2）值均升高，两组之间无差异。布比卡因的血浆浓度未达到中毒值，且在研究期间未发现中枢神经毒性症状或任何其他不良反应。临床上，胸膜腔内注射布比卡因后有一定程度的疼痛缓解。布比卡因注入后30分钟时的VAS和PQ评分降低程度与羟考酮治疗后相似。布比卡因组手术当天对镇痛药的需求比对照组少（P<0.001）。然而，布比卡因组术后48小时内羟考酮补充剂量的数量并不比对照组少。
